Implementation Framework

Based on THOR-AABB International Standards and proven deployment models

THOR-AABB Four Pillars Framework

1

Rationale & Product Selection

  • Low-Titer O-Positive Whole Blood (LTOWB) - Primary product
  • Contains RBCs, plasma, and platelets in natural ratios
  • Universal donor compatibility with low antibody titers (<256)
  • Safer and simpler than component therapy
  • Alternative: Packed RBCs + plasma combination
2

Storage & Distribution

  • FDA-approved coolers maintaining 1-6°C temperature
  • Temperature monitoring with remote alarms
  • Validated storage containers (e.g., Peli Biothermal)
  • Strategic deployment using utilization heat maps
  • Rotation systems to minimize wastage
3

Transfusion Criteria & Personnel

  • Indication: Hemorrhagic shock with SBP ≤90 mmHg
  • Evidence of significant blood loss (>500 mL)
  • Penetrating trauma with instability
  • Personnel: Trained ALS paramedics
  • Competency-based certification required
  • Medical director oversight and protocols
4

Documentation & Handover

  • Pre- and post-transfusion vital signs
  • Blood product tracking numbers
  • Transfusion reaction monitoring
  • Electronic health record integration
  • Hospital notification protocols
  • Standardized handoff procedures

24-Month Implementation Roadmap

1

Planning & Stakeholder Engagement

Months 1-3
Form Implementation Committee
  • DCAS clinical and operational leadership
  • Medical directors
  • UAE blood bank representatives
  • Hospital emergency departments
  • Ministry of Health representatives
Conduct Needs Assessment
  • Analyze trauma registry data
  • Identify target patient population
  • Map high-utilization geographic areas
  • Assess current hemorrhagic shock outcomes
Develop Business Case
  • Cost-benefit analysis for Dubai
  • Projected lives saved calculation
  • Equipment and training budget
  • Sustainability strategy
2

Regulatory & Operational Framework

Months 4-6
Establish Regulatory Compliance
  • Align with UAE Ministry of Health regulations
  • Develop Dubai-specific protocols
  • Secure necessary approvals and licenses
  • Establish AABB accreditation pathway
Create Operational Protocols
  • Transfusion criteria and indications
  • Storage and handling procedures
  • Quality assurance protocols
  • Documentation requirements
Secure Blood Supply Chain
  • Partner with Emirates Blood Transfusion Center
  • Establish low-titer blood specifications
  • Develop rotation systems
  • Create emergency resupply protocols
3

Infrastructure & Training

Months 7-9
Acquire Equipment
  • FDA-approved blood storage coolers
  • Temperature monitoring systems
  • Blood warming devices
  • Infusion equipment and supplies
Develop Training Program
  • Adapt THOR network training materials
  • Create competency-based certification
  • Transfusion reaction management
  • Documentation and handover training
  • Arabic language materials
Design Pilot Program
  • Select initial deployment areas
  • Determine vehicle/unit allocation
  • Establish performance metrics
  • Set up monitoring systems
4

Pilot Implementation

Months 10-15
Launch Pilot Program
  • Deploy blood on selected supervisor vehicles
  • Activate 24/7 medical oversight
  • Implement real-time case review
  • Maintain hospital communication
Monitor & Optimize
  • Track all transfusions and outcomes
  • Monitor wastage rates
  • Refine protocols based on experience
  • Address operational challenges
Stakeholder Communication
  • Regular reporting to partners
  • Blood bank coordination
  • Public education campaign
  • Media engagement
5

System-Wide Expansion

Months 16-24
Scale Operations
  • Increase equipped vehicles progressively
  • Extend geographic coverage
  • Train additional paramedic cohorts
  • Optimize deployment strategies
Continuous Improvement
  • Ongoing case review and analysis
  • Protocol refinement
  • Technology upgrades
  • Performance optimization
Regional Leadership
  • Share best practices with other Emirates
  • Establish DCAS as regional center of excellence
  • Collaborate on research
  • Plan for future innovations

Deployment Model Options

Supervisor/QRV Model

Recommended for DCAS

Description: Blood products carried by EMS supervisors or Quick Response Vehicles strategically positioned across Dubai.

Advantages:

  • Lower initial cost
  • Reduced wastage risk
  • Centralized expertise
  • Rapid response (minutes)

Used by: Maryland, Washington DC, multiple urban systems

All-Ambulance Model

Future Expansion

Description: Blood products on all advanced life support ambulances across the system.

Advantages:

  • Immediate availability
  • No wait for supervisor
  • Maximum coverage

Challenges:

  • Higher inventory costs
  • More wastage management needed

Used by: San Antonio, select rural systems

Critical Care Model

Complementary

Description: Blood products on helicopter EMS and critical care transport units.

Advantages:

  • Scene and interfacility
  • Experienced crews
  • Extended transport times

Application:

  • Can complement ground program
  • Excellent for remote areas

Used by: Widely adopted internationally

Key Success Factors

Stakeholder Buy-In

Leadership Commitment: Strong support from DCAS management
Hospital Partnership: Active collaboration with receiving facilities
Blood Bank Coordination: Reliable supply chain partnerships
Government Support: Ministry of Health approval and backing

Operational Excellence

Rigorous Training: Comprehensive, competency-based education
Clear Protocols: Evidence-based clinical guidelines
Quality Assurance: Ongoing monitoring and case review
Data-Driven Decisions: Performance metrics and optimization

Ready to Build the Implementation Plan?

Review the financial analysis and detailed action steps to bring this life-saving program to DCAS.

Financial Analysis Detailed Action Plan